Association of Smoking Status and E-Cigarette Use for Cessation with Remission from Alcohol or Substance Use Disorders

Background/Purpose: Tobacco use remains one of the main risk factors for preventable diseases and deaths in the US. Tobacco use is disproportionately concentrated among vulnerable populations served by social workers. Individuals with alcohol use disorder (AUD) and/or substance use disorders (SUDs) have greater lifetime tobacco use rates than those without such conditions. Smoking cessation is critical for these individuals as adults in remission who smoke are more likely to relapse whereas those who quit smoking have higher rates of recovery success. Individuals in SUDs treatment report using e-cigarettes for cessation; however, evidence on the effectiveness of e-cigarettes as a cessation tool is inconclusive. This study addresses the following questions: What are the current rates of AUD/SUDs in remission among former and current smokers? Among former smokers, what sociodemographic factors are associated with remission? And finally, what is the relationship between cessation-related e-cigarette use and remission?

Methods: The sample of former and current smokers (n=15,965), nationally representative of 107.9 million adults, was obtained from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). DSM-5 criteria were used to determine past-year AUD/SUDs remission. Respondents indicated whether they used e-cigarettes for help with tobacco use in the last 12 months. We used bivariate and multivariate logistic regression models to examine associations between sociodemographic factors and smoking status. Using a series of multivariate-adjusted logistic regression models, we also examined remission among former smokers and among users of e-cigarettes for cessation. Analyses were performed in Stata 16.0.

Results: Of the sample, 22.8% were in past-year AUD remission and 11.7% were in past-year SUDs remission. Former smokers had lower rates of SUDs remission (8.5%) compared with current smokers (13.9%) (p<.001). Among former smokers (n=5,926), factors positively associated with AUD remission included: gay/lesbian (adjusted odds ratio [AOR], 4.38; 95% confidence intervals [CI], 1.26-15.27) or bisexual identity (AOR, 17.69; 95% CI, 1.68-185.85) and past-year SUDs remission (AOR, 2.14; 95% CI, 1.01-4.53). Factors positively associated with SUDs remission included being employed (AOR, 3.44; 95% CI, 1.34-8.86) and past-year AUD remission (AOR, 2.32; 95% CI, 1.07-5.01). Past-year drug/alcohol treatment and past-year anxiety disorder were positively associated with AUD and SUDs remission (p<0.05 for each). Age and female sex were associated with a decreased likelihood of current AUD or SUDs remission (p<0.05 for each).

Among users of e-cigarettes for cessation (n=383), non-Hispanic Black (AOR, 0.16; 95% CI, 0.05-0.71) and gay/lesbian (AOR, 0.07; 95% CI, 0.01-0.66) individuals had decreased likelihood of AUD remission. Factors positively associated with SUDs remission were bisexual identity (AOR, 8.09; 95% CI, 1.35-48.32); past-year AUD remission (AOR, 1.84; 95% CI, 1.02-3.34); and past-year drug/alcohol treatment (AOR, 2.96; 95% CI, 1.12-7.82). Female sex was associated with a decreased likelihood of current SUDs remission (AOR, 0.33; 95% CI, 0.17-0.63).

Conclusions/Implications: Cessation-related e-cigarette use was not associated with smoking status, and e-cigarettes may not serve as an effective smoking cessation tool for some individuals attempting AUD/SUDs recovery or smoking abstinence. Social workers who work with adults in or seeking AUD/SUDs treatment should assess e-cigarette use and reason for use.